Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information

CMS's description

The Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information files contain formulary, pharmacy network, and pricing data for Medicare Prescription Drug Plans and Medicare Advantage (MA) Prescription Drug Plans (with the exception of employer and Program of All-Inclusive Care for the Elderly plans). These non-identifiable files are available on a quarterly basis and are comprised of the following tables:Plan Information - Information such as plan name, contract ID, plan ID, service area, and plan type.Geographic Locator - MA and Prescription Drug Plans region codes and county codes.Basic Drugs Formulary - Formulary details for each plan including National Drug Codes (NDCs), cost share tier level, and indicators for step therapy, quantity limits, prior authorization, and a newly added Selected Drug flag.Excluded Drugs Formulary - Enhanced alternative plans may elect to provide a supplemental benefit and cover excluded drugs. File includes formulary details for excluded drugs that are covered by the plan (for enhanced alternative plans only).Beneficiary Cost - Plan level cost sharing details for preferred, non-preferred, and mail order network pharmacies.Pharmacy Network - National Provider Identifier (NPI) numbers for each network pharmacy including preferred, retail, and mail order indicators, and brand, generic, and selected drug dispensing fees for 30/60/90 days supply, respectively.Pricing - Plan level average monthly costs for formulary Part D drugs (note: this table is only available in the quarterly files).Indication Based Coverage Formulary File - Includes drugs covered based on FDA-approved indication for each plan.Insulin Beneficiary Cost File - Plan level copay and coinsurance amounts for insulin at preferred, non-preferred and mail order network pharmacies. These are large files and can take time to download. Please read the “Agreement for Use” in the Resources section below. This document contains important information regarding timeframes for obtaining data as well as data accuracy and integrity. The Monthly Prescription Drug Plan Formulary and Pharmacy Network Information is also available to access for the monthly level information. Please note: The Part D benefit year information for plans become available in October of the year prior. For example, year 2025 data is available in the fourth quarter file of 2024. Year 2025 data continues to be available in the Q1-Q3 2025 files, then in the fourth quarter of 2025 year 2026 data becomes available. Estimated release dates for upcoming quarterly data (files reflect data for the quarter that ended the month before the file was released):1/20/20274/28/20277/21/2027Files older than contract year 2019 can be purchased.

Methodology and other documents from CMS:

• Methodology SPUF 2026 (PDF)

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